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Pilonidal Disease

WHAT IS PILONIDAL DISEASE AND WHAT CAUSES IT?

Pilonidal disease is a chronic infection of the skin in the region of the buttock crease.  The name comes from the Latin for hair; pilo- and nidus for nest.  Therefore translated means nest of hairs.

The exact cause is debated, but it seems likely that for some reason hairs drill into the skin to cause small pits which then open up into a cavern or bigger cavity.  The ridges on human hair may cause a ratchet type effect which causes hair to be drawn into the cavity.

It is usually characterised by the presence of several small pits which are can be difficult to see.  They lead to a larger cavity which gets infected and discharges from time to time.  The disease is more common in men than women and frequently occurs between puberty and age 40.

Most patients have an episode of an acute abscess (the area is swollen, tender, and may discharge pus).  After the abscess resolves, either by itself or with antibiotics, many patients develop a pilonidal sinus.  The sinus is a cavity beneath the skin surface that connects to the surface with one or more small openings or tracts.  Although a few of these sinus tracts may resolve without therapy, most patients need a small operation to eliminate them.

WHAT ARE THE SYMPTOMS?

Symptoms vary from a small dimple to a large painful mass.  Often the area will discharge fluid that may be clear, cloudy or bloody.  Acute infection can arise and then the area becomes red, tender, and the discharge or pus will be foul smelling. The infection may also cause fever, nausea or lethargy and a general feeling of being ill.

Surgery of some sort is almost always required to resolve this condition.

HOW IS PILONIDAL DISEASE TREATED?

The treatment depends on the disease presentation.

An acute abscess is usually best managed with an incision and drainage to release the pus, and reduce the inflammation and pain. This is often performed on an urgent or even emergency basis.  

A chronic sinus usually will need to be excised or surgically removed.

Complex or recurrent disease must be treated surgically. Procedures vary from de-roofing the sinuses to excision and possible closure with flaps.

If the wound is left open, it will require dressing or packing to keep it clean.  Although it may take several weeks to heal, the success rate with open wounds is higher. Closure with flaps is a bigger operation that has a higher chance of infection; however, it may be required in some patients.

WHAT CARE IS REQUIRED AFTER SURGERY?

If the wound can be closed with stitches, it will need to be kept clean and dry until the skin is completely healed.  If the wound is  left open, dressings or packing will be needed to help remove secretions and to allow the wound to heal from the base.

After healing, the skin in the buttocks crease must be kept clean and free of hair. The easiest way of keeping the area hair free is by using hair removal creams.  Some patients do have there partner help by shaving the area.

If you wish to arrange an appointment with Dr. Rob Church at Al Zahra Hospital Dubai

Contact Al Zahra Call Center on +971 4-378-6666